Management and treatment algorithm of airway complications after anterior cervical spine surgery: systematic review

Background: Airway-related complications are rare after cervical spine surgery but can be devastating and compromise a successful outcome. The objective of this systematic review is to provide an overview of the management of airway complications after anterior cervical spine surgery (ACSS) and propose a treatment algorithm for approaching the patient with a compromised airway.

Methods: A literature search was conducted in PubMed and adapted for use in other databases, including the Cochrane Register of Controlled Trials, Cochrane Library Health Technology Assessment Database, Embase, and the National Health Service (NHS) Economic Evaluation Database.

Results: A total of 117 papers received a full text review. Thirty-seven studies were categorized as "management" and included. An additional four references were extracted from other references for a total of 41 studies.

Conclusions: Most of the available evidence on airway compromise after ACSS is level III or IV. Similarly, most available evidence on the management of acute airway complications comes from case reports or anecdotal publications. There are currently no methods in place to stratify the risk of airway complications in patients undergoing these guidelines on the management of these complications when they occur. This review is focused on practice, including management of such complications with a proposed treatment algorithm.